Everyone knows that sleep is important. Research in sleep science (yes, this is a thing) tells us that our brains are working to digest the day’s learning, the immune system is active during sleep, and our bodies are repairing and renewing tissues and organs while we slumber. As much as we need sleep, kids need it more. They are building the brains and bodies they will carry into their future. Children need good quality sleep as much as they need healthy food.
Helping children to sleep well is usually a combination of creating good and consistent bedtime routines, giving them a full day of physical action and warm social interaction, and developing a healthy sleep environment. This means providing a sleep-positive environment and removing any barriers to sleeping well. But giving kids the chance to get a good night’s sleep can be harder when a child has hypermobility.
Some of the challenges to sleep for hypermobile kids are sensory-based, some are related to activity during the day, and some are orthopedic. Here is a list of things that make sleep more challenging for these kids:
- Children with limited proprioception and kinesthesia due to low tone or excessive joint mobility can have difficulty shifting down into a quiet state for sleep. They spend their day seeking sensory input; not moving reduces the sensory information that makes them feel calm and organized. Being still is a bit similar to being in a sensory deprivation tank, and it’s not always calming. To understand more about the sensory concerns of hypermobility, take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children.
- Some hypermobile kids have joint or muscle pain that keeps them up or wakes them up in the middle of the night. Pain also makes kids more restless sleepers. Restless sleepers thrash around a bit under the covers, becoming trapped in multiple layers of bed linens, or they can fall asleep in awkward positions that result in pain.
- Children that are sedentary during the day for any reason (preference for tablet or video play, fatigue, pain, etc) may not be physically tired enough at night. They may also be staying up too late at night. Good sleep hygiene includes enough daytime activity combined with a conscious wind-down hours before bedtime occurs.
- Some children with generalized low tone or joint hypermobility (especially with a connective tissue disorder) have issues with the partial collapse of their airway during sleep. They snore or gasp in their sleep, and appear exhausted even after a full night’s sleep. This is a serious issue. Sleep apnea should be evaluated and addressed by a professional.
- Hypermobile kids can get arms and legs caught in their bedclothes or between crib slats and mattresses. Any layer can be a potential problem, from the sheet to the decorative afghan that Granny sent for his birthday. For more information on hypermobility and safety, read Safety Awareness With Your Hypermobile Child? Its Not a Big Thing, Its the Biggest Thing
- Limbs can slide off the mattress during deep sleep and create strain on ligaments and tendons. You and I depend on our brain to perceive an awkward position and take corrective action by waking us slightly. The same child who “w” sits and slides off a chair without noticing is not going to wake up when her arm is hanging off the bed during sleep, even though the tissues are stretching beyond their typical range of motion.
- Waking up to go to the bathroom or having to clean up a nighttime accident ruins sleep. It isn’t uncommon to have older kids wear protective garments well past 5 at night, and some children need to practice holding in their urine to expand the bladder’s ability to hold it all night long. This is something to discuss with your child’s urologist or pediatrician, since “holding it in” can be it’s own problem. Read Teach Kids With EDS Or Low Tone: Don’t Hold It In! to learn more about the pitfalls of too much “holding”.
Here are some simple strategies that may improve your child’s sleep:
- Try a duvet or a flannel sheet set to minimize the number of layers of bedclothes.
- Use a rashguard suit instead of pajamas. I am particularly fond of the zip-front style so that less force is needed to get arms in and out while dressing. You can peel it off more easily. The lycra creates sensory feedback that can support body awareness while keeping them cozy. An all-in-one suit also gives a bit of support so that limbs don’t easily overstretch. A little bit of proprioceptive input in a breathable fabric that can also generate a bit of neutral warmth (from body heat) to keep tissues from getting too stiff.
- Avoid footie sleepers that are too short. Too-small footie sleepers create compressive forces on joints and could even encourage spinal torque. Hypermobile kids will be the last ones to complain since they often don’t feel discomfort right away. My preference is not to use these sleepers at all with hypermobile kids or kids with low tone. See the next suggestion for another reason why I feel this way.
- Make them take off those footie sleepers when they wake up and walk around. As fabric twists and children stand/walk on the fabric, not the soles, it creates a safety risk underfoot. Less sensory feedback and slippery soles!! Get them dressed once they wake up.
- Address sleep apnea, lack of daytime activity, and toilet training/scheduling rather than waiting for things to improve. Not all young children achieve night time dryness on pace with other children, but ignoring the impact isn’t going to help things.
- Carefully consider safety issues before you try a weighted blanket. Originally sold for kids on the autistic spectrum and for kids with sensory processing disorders without muscular or orthopedic issues, these blankets have become popular with other groups. The biggest concern for hypermobile kids is that placing weight (meaning force) on an unstable joint over time without conscious awareness or adult monitoring is a safety issue. It is possible to create permanent ligament injury or even subluxation of a joint with weights, depending on a limb’s position, the length of time weight is applied, and the amount of force placed on a joint. Talk the idea of a weighted blanket over with your OTR or PT before you order one of these blankets.
- Consider aromatherapy, gentle massage, white noise machines, and other gentler and less invasive sleep strategies to help your child sleep well. Consider techniques like gentle joint compression and/or deep pressure brushing, but ask your therapists how to adapt it for your child’s specific needs Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome?. For kids who sleep well but wake up stiff, learn how to use gentle massage and possibly heat to help them get going. Do not ignore pain at bedtime, or complaints of pain on awakening. These are important clues that you need to address. Ask your occupational therapist or your pediatrician for ideas to adapt your bedtime routine (your OT) or your pain plan ( your MD) to handle nighttime pain.
- Try K-Taping or Hip Helpers for stability. Kineseotape stays on for days and gives joint support and sensory input while your child sleeps. Hip Helpers are snug lycra bike shorts that limit extreme hip abduction for the littlest kids when their legs rotate out to the sides excessively. They gently help your child align hip joints correctly. As with weighted blankets, I strongly recommend consulting with your therapists to learn about how to use both of these strategies safely. When used incorrectly, both can create more problems for your child. Simply put, any strategy that could help could also be misused and create harm.
Need more information about managing hypermobility in children? Take a look at Should Your Hypermobile Child Play Sports? , Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection Strategies and Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior
Announcing my new e-books on pediatric hypermobility!
There are now TWO e-books for the parents and therapists of hypermobile kids ages 0-5 and 6-12!
The JointSmart Child: Living and Thriving With Hypermobility Volume One: The Early Years is the first e-book in the series. It is a practical manual for parents and therapists. Learn more about how hypermobility affects sensory and behavioral development as well as motor skills, and how to pick the right equipment to help a child thrive! There are ideas for every ADL skill and even strategies to talk with your family and doctor about your child’s needs. Read more about this book at The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! You can buy this unique new book as a clickable and printable download at Your Therapy Source or as a read-only download at Amazon.com
The JointSmart Child: Living and Thriving With Hypermobility Volume Two: The School Years takes things further and deeper. It is a larger book, filled with information to make life easier, safer and more independent for kids 6-12. Learn how to pick the best chairs, desks, bikes, even the best sports and musical instruments for a child. Understand the best ways to communicate with your child’s teachers and medical providers to get the results you want. This book has an extensive appendix with forms and handouts for parents and therapists alike. There are even some simple recipes to build fine motor and sensory skills through cooking. It is available on Amazon and on Your Therapy Source and you don’t need a kindle to download it; they have a simple way to load it on your phone or iPad! Read more about this book here: Parents and Therapists of Hypermobile School-Age Kids Finally Have a Practical Guidebook!